Telehealth to Enhance PrEP Awareness Among Women Who Sell Sex: A Community-Embedded Approach

Women who sell sex (WSS) experience a disproportionate burden of HIV due to various structural barriers and social inequities. While pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition, awareness and uptake among WSS remains low. Telehealth offers the opportunity to address common barriers to care by embedding PrEP services within trusted community spaces. This study evaluates the acceptability and preliminary effectiveness of a community-embedded telehealth approach to engage WSS in the PrEP care continuum, with a specific focus on expanding awareness. Participants were recruited from two community-based drop-in centers in a Midwestern U.S. city from November 2023 to January 2024. Pre-visit surveys were obtained to assess baseline PrEP knowledge and intention to use PrEP, followed by a 15-30-min telehealth visit with a PrEP provider. Post-visit surveys and qualitative interviews assessed changes in PrEP knowledge, telehealth acceptability, intention to use PrEP, and barriers and facilitators to PrEP uptake. PrEP knowledge and intention to use PrEP increased post-intervention compared to baseline. Qualitative findings highlighted high community-embedded telehealth acceptability, low baseline PrEP awareness, a desire to share new PrEP information with peers, and the need for innovative PrEP outreach strategies. This study supports telehealth as a strategy to increase awareness of PrEP among WSS. Targeted public health messaging and expanded integration of PrEP into community and primary care settings is warranted. Future research is needed exploring strategies for sustained engagement and linkage to long-term PrEP care.